4 Answers

For NH Medicaid, they must show that 1) are 65+, 2) medical condition requires a skilled level of Nursing care, 3) monthly income is less than their states Medicaid ceiling, about 2K, 4) countable assets are less than $2K and 5) not gifted away anything of value during the look-back period.

Fed’s have 5 yrs as the max look-back. Most states require 3 – 6 mo of financials with application. Can require more documents if something pique’s interest. A “transfer penalty” can happen when items are gifted below value.

All assets are counted against the state’s ceiling unless the assets fall within the short list of "noncountable" assets: -personal possessions & - a vehicle, -their principal residence, provided it is in the same state in which the individual is applying for coverage & the house may be kept with no equity limit if the "community spouse" lives there; otherwise the equity limit is 500K (750K in some) -prepaid funeral plans (irrevocable, NCV)-small amount of life insurance (NCV)Over that they must “spend down” to get to their states ceiling.

If you mom truly only has SS and no other assets, savings or income, then she likely meets her state's $ requirement to qualify for Medicaid.

The medical aspect for Medicaid acceptance can be tricky - most NH residents get in because they are discharged from the hospital and need skilled nursing or rehabilitation. Getting into a NH this way is especially good as Medicare will pay for the first few # of days if you were in the hospital prior. Medicare site has details.

After that, LTC in a facility/NH are either private pay, LTC insurance or Medicaid.

If they are at home, then you will have to have her doctor evaluate her and recommend NH placement. There are a # of criteria that they will use to do this.Just being old, or having incontinence, or dementia is not enough.

My mom went from IL to NH. She bypassed the AL stage because she had a critical weight loss (more than 10% in 60 days), hallucination, critical H & H; & she refused to take her medications, plus some other issues. She was visited by the NH admissions nurse to be evaluated to see if she could be taken care of in their facility. Now this is required to be done - even though her gerontologist was the medical director of the nursing home. Sometimes you will need the doctor to change her meds in order to pass Medicaid review. Like needing the Exelon patch rather than the pill - patch requires more "skill" to do properly, or they need some sort of feeding supplement that needs to be compounded which you can't do at home so needs more "skill" to do accurately. Or they may need to take a daily aspirin so that it is documented they have a coronary condition.

If you mom has significant health issues - kidney dialysis, unmanageable diabetes, a cancer - then she's already there for needing skilled nursing. If not, then you are going to need to work with her doctors to get the right diagnosis and meds so she can pass the review.– One thing you want to do is find a NH that will accept her "Medicaid Pending", if you have limited finances of your own. This is VERY important. What Medicaid Pending means is the NH will accept your mom as a resident and the payment for her care will be whatever her SS is less her states personal needs allowance.So if she get's $ 1,200 in SS and her states pna is $ 60, then you write them a check from mom's account (where her SS gets deposited into) for $ 1,140.00 and you or mom do not owe for the difference in what the actual monthly NH rate is.

Some NH do not do Medicaid Pending even though they take Medicaid - in these you have to make up the difference which you get back when she gets accepted into Medicaid. Now the application can take weeks, even months in some states, so this can get super expensive.

You need to find the statement that your mom should have gotten in the mail in December from SSA that shows what she will get for 2012. It is a 1 page tri-fold, that shows her SS and the amount taken out for Medicare each month. This is what the NH will use as their basis for what they expect her to pay monthly. There are a lot of other documents needed for Medicaid. It really depends on your state's program. Good Luck.

If your mother only has social security income then i suggest you have her apply for Medicaid in which is the only insurance that will pay for a long term care facility or nursing home. I could help more if i knew her amount of income she earns each month. There are several options for her, all depending on her income.

I know the term"facility" has an ugly name for most of us. However, my father was in 8 facilities in 8 months and was very happy at all of them except the last one. There are so many issues we do not understand until we reach a certain age. I know that at 56 I view the world a little differently and my priorities have changed. What you view as "lazy" may simply be a lack of physical strength, an illness, depression, or another issue. When money becomes an issue for our parents who lived through the Depression, feelings of anger , hopelessness and fear can become a reason to give up on life. Try to find a place for your mother that is clean and safe. There are boarding houses for the elderly with caregivers who can provide supervision of medication in some cities. I hope things work out for all of you quickly.

From what I have learned you would apply for medicaid if her income is less than $2,000 a month (something like that) and she would be entitled to live in any facility that accepts Medicaid patients. They would take her entire SS check but let her have a certain amount to live on monthly.

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